Treatment of urinary tract infections in the old and fragile
Treatment of urinary tract infections in the old and fragile
复制标题
年老体弱者尿路感染的治疗
DOI：
10.1007/s00345-020-03159-2
复制
发表时间：
2020
影响因子：
3.4
通讯作者：
Ayberk Bayramgil
中科院分区：
文献类型：
--
作者：
Guohua Zeng;Wei Zhu;Wayne Lam;Ayberk Bayramgil
前言泌尿道感染（UTI）在年老体弱的人群中非常普遍.本次审查的目的是概述的诊断，治疗和预防UTI在体弱老龄化population.MethodsPubmed和Web的科学搜索，以确定出版物，直到2019年3月有关的管理UTI在老年人口进行。对现有文献进行了叙述性综述。结果64篇出版物被认为相关并纳入本综述中。在老年和脆弱的症状性尿路感染的诊断可能具有挑战性。对年老体弱的无症状菌尿患者不推荐常规筛查和抗菌治疗。应根据泌尿系病原菌培养及药敏结果慎重选择抗生素。了解当地抗生素耐药率在选择适当的抗菌治疗中起着重要作用。在老年人有症状的UTI中，在决定抗生素的选择时，应考虑相关不良反应的影响，特别是对认知功能的影响。合并症，如糖尿病的最佳管理，尿失禁的充分治疗，明智地使用导尿管是必不可少的，以减少UTI.ConclusionUTI的发展是一个显着的，但在老年人口中常见的问题。照顾体弱老年患者的医生必须意识到无症状性UTI管理的挑战，并在这一人群中识别有症状的UTI，以及他们适当的管理策略。有强烈的需要在研究中，以评估非抗菌药物治疗在预防UTI的体弱老年人群。
IntroductionUrinary tract infection (UTI) is highly prevalent in the frail elderly population. This review aimed to outline the diagnostic, treatment, and prevention of UTI in the frail aging population.MethodsPubmed and Web of Science search to identify publications until March 2019 relating to the management of UTI in the elderly population was performed. A narrative review of the available literature was performed.Results64 publications were considered as relevant and included in this review. The diagnosis of symptomatic UTI in the old and fragile could be challenging. Routine screening and antimicrobial therapy for asymptomatic bacteriuria should not be recommended for frail elderly patients. Cautious choice of antibiotics should be guided by uropathogen identified by culture and sensitivity. Understanding local antibiotic resistance rates plays a fundamental part in selecting appropriate antimicrobial treatment. Impact of associated adverse effect, in particular those with effects on cognitive function, should be considered when deciding choice of antibiotics for symptomatic UTI in the elderlies. Optimal management of comorbidities such as diabetes mellitus, adequate treatment of urinary incontinence, and judicious use of urinary catheter is essential to reduce the development of UTI.ConclusionUTI is a significant but common problem in elderly population. Physicians who care for frail elderly patients must be aware of the challenges in the management of asymptomatic UTI, and identifying symptomatic UTI in this population, and their appropriate management strategies. There is strong need in studies to evaluate nonantimicrobial therapies in the prevention of UTI for the frail elderly population.